a Department of Intensive Care, Erasme Hospital , Université libre de Bruxelles , Brussels , Belgium.
Expert Rev Anti Infect Ther. 2019 Mar;17(3):169-175. doi: 10.1080/14787210.2019.1581606. Epub 2019 Feb 26.
Sepsis, defined as infection plus some degree of organ dysfunction, is still associated with high mortality and morbidity rates. Management focuses on three key areas: infection control, hemodynamic stabilization and organ support, and modulation of the sepsis response. Areas covered: This review will not cover infection control. Hemodynamic stabilization essentially involves the use of adequate fluid resuscitation and vasopressors. Fluid and vasopressor choices and targets are discussed, and the need to adapt these to the individual patient is stressed. No drugs are currently available that modulate the sepsis response, with the possible exception of corticosteroids in the most severe cases. The place of vasopressin is not well defined. Some of the immunomodulatory agents currently in development are briefly discussed. Expert opinion: Management of the patient with sepsis remains a challenge and needs to be personalized. The search for new immunomodulatory drugs continues and will be facilitated by better characterization of patients using modern 'omics' technology and complex analysis of the large quantities of clinical data increasingly available.
脓毒症，定义为感染加上一定程度的器官功能障碍，仍然与高死亡率和高发病率相关。管理侧重于三个关键领域：感染控制、血流动力学稳定和器官支持，以及脓毒症反应的调节。涵盖领域：本综述将不涵盖感染控制。血流动力学稳定实质上涉及使用足够的液体复苏和血管加压药。讨论了液体和血管加压药的选择和目标，并强调需要根据个体患者进行调整。目前没有可调节脓毒症反应的药物，在最严重的情况下，皮质类固醇可能除外。血管加压素的作用尚未明确。目前正在开发的一些免疫调节剂简要讨论。专家意见：脓毒症患者的管理仍然是一个挑战，需要个性化。正在继续寻找新的免疫调节剂药物，并且将通过使用现代“组学”技术更好地对患者进行特征描述，以及对越来越多的大量临床数据进行复杂分析来促进这一研究。
